March 28, 2025 • 19 mins
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The dangerous intersection of diabetes and infection takes center spotlight in this vital conversation between nurse practitioners Nicole and Kelli. They reveal a startling medical reality that deserves immediate attention: infections have risen to become the third leading cause of death in patients with type 2 diabetes.
Moving beyond typical weight-loss discussions that dominate health conversations, especially during resolution season, they emphasize that true health and wellness should be our primary focus. With obesity linked to over half of new type 2 diabetes diagnoses annually, understanding proper management becomes critical. The practitioners explain the dangerous cycle that occurs during infection: blood glucose rises naturally, creating an environment where bacteria thrive, while chronically elevated blood sugar creates blood that's "like syrup," making oxygen delivery difficult precisely where it's needed most.
The conversation delivers practical, actionable advice for diabetic patients and those at risk. Protein intake recommendations (roughly equivalent to body weight in grams for maintenance, or about one-third of daily calories for those trying to lose weight) provide clear nutritional guidelines. They stress the importance of early intervention for suspected infections, proper hydration alongside increased protein consumption, and regular monitoring of laboratory values like albumin levels. A final gem for listeners: information about new at-home combination tests that check for multiple respiratory infections simultaneously, allowing for prompt telehealth treatment without leaving home during infection season. Whether you're managing diabetes, supporting someone who is, or simply interested in preventative health, this episode delivers crucial information that could quite literally save lives.
Have you checked your protein levels lately? Connect with us at hamiltontelehealth.com to discuss your health concerns from the comfort of home.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nicole (00:07):
Hey everyone, welcome to another episode of Tattoos and
Telehealth.
My name is Nicole, I'm a nursepractitioner.
This is my great colleague,Kelli, she's also a nurse
practitioner.
And today is my great colleague, Kelli, she's also a nurse
practitioner, and today we'regoing to talk about some pretty
(00:28):
important stuff, especiallyrelated to those with diabetes.
Just as a disclaimer, ourlawyers make a say this does not
constitute a patient providerrelationship and this is not to
be construed as medical advice.
Just two gals talking andhaving a conversation.
So go ahead, Kelli, take it off, let's go.
Kelli (00:47):
So today I kind of want to back up a little bit in the
world of all of the fancy stuff.
But you know, we, we kind ofget especially around the
holidays in the sense of reallytalking about our weight and you
know, those of us gym rats likemyself, we start to notice that
people really get excited about, you know, the first of the
(01:09):
year and we set new year'sresolutions and the gym starts
to become busy and everybodyreally kind of starts getting
focused on that.
But I really want to come backdown to the fact that health and
wellness should be the goal,right?
So instead of weight loss, wereally should be considering
health and wellness as the goal,and with that comes weight loss
(01:30):
, because once you start tobecome more healthy, you will
get that weight off.
Now, the reason why Nicole andI get really really, really
excited about this and we reallykind of hit hard about this is
that one of the biggest, biggestburdens of being overweight,
even just slightly overweight,is the increased risk for
developing type two diabetes.
(01:50):
Right, like?
I don't remember the number.
Do you remember the number,nicole?
The percentage?
Nicole (01:56):
It's over 50.
And I can't think of what thenumber exact number is, but I'll
.
I'll look it up while you'retalking and we'll go from there.
It's the number obesity.
Go ahead, you continue talkingand I'll look it up while you're
talking and we'll go from there.
It's the number obesity.
Go ahead, you continue talkingand I'll look it up.
I'll look in our database.
Kelli (02:09):
The reason why is, as clinicians, we always worry
about patients that are diabeticwhen they present to us with
infections an infection of anykind, really right.
So I get super, super stressedabout skin infections in my
diabetics, especially skininfections in the lower limbs,
because I don't know about you.
But I get super, super stressedabout skin infections in my
diabetics, especially skininfections in the lower limbs,
because I don't know about you,but I get worried about it
(02:29):
getting into the tissues,getting down into the bone that
patient developing osteomyelitis, which is, in layman's terms,
infections that get into thebone of the patient I worry
about to treat.
Yeah, I worry about infectionsin the feet and the reason why
I'm circling back to this rightnow is that some of the latest
(02:51):
articles that are coming outthat Nicole and I get inundated
with daily is one of the morepopular articles that we ascribe
to has just released an articletalking about infections in
type two diabetics and howinfection, just infection
(03:12):
overall, any infection of anykind, infections overall has
risen to the third leading causeof death the third, nicole, of
death in type 2 diabetics.
So patients with diabetes as awhole, infection in general, has
risen to the third leadingcause of death in our patients
with diabetes and that freakedme out.
I was like.
You know how many of mydiabetic patients I treat for
infections, and it's just ingeneral.
Nicole (03:32):
Yeah, so there's so many that it goes beyond just an
acute infection.
But sepsis and that's what Kellitalking about is it goes from
just a in just a, an infectionin, you know, in a small wound
or in a scratch or in whatever.
We don't have good blood supplyas diabetics in the lower
extremities, typicallyespecially advanced, and you
(03:53):
need blood supply with oxygen toheal.
And because the blood supply ispoor to the lower extremities,
it has trouble healing.
So because it has troublehealing, it spreads and it
spreads to be sepsis and that iswhere it's in your bloodstream,
it's everywhere, or, like Kellisaying, it goes to the bone and
that's a huge problem becausethat's when you end up with a
(04:15):
lot of amputations, is when youget the osteomyelitis.
But I did find that obesitysignificantly increases the risk
of developing type 2 diabetesand studies indicate individuals
with obesity are nearly threetimes more likely to be
diagnosed with type 2 diabetesand obesity has been linked to
53 percent of new type 2diabetes diagnoses annually in
(04:39):
the United States.
So this certainly, certainlyenhances the criticality of
making sure that we are reducingthe prevalence of type 2
diabetes, and that is withhealth and wellness and obesity
management Exactly.
Kelli (04:55):
And I want to stress, we are strictly talking about type
2 diabetics today.
I have a lot of love forautoimmune diabetes and type 1
diabetics hold a special placein my heart, but that is a very,
very different conversation.
Okay, so we're not talkingabout you're not talking about
type one diabetics.
We are not talking aboutjuvenile diabetes.
We are talking aboutspecifically type two diabetes.
Okay, guys, so we're not that.
(05:17):
That is a very differentconversation, okay, and the
takeaway to that is that, asyears have gone by, studies have
shown that, as the proportionof deaths have increased to
infection, specific diagnosiscodes even things like pneumonia
(05:37):
has become so prevalent incausing infection related deaths
in diabetics.
It was startling to me and Iwant to get back to visiting for
just a little bit with patientsthat have diabetes and chatting
(05:57):
with you about the importanceof recognizing signs and
symptoms of infection.
Now, this is specifically againfor our diabetes patients.
If you feel like something thatyou are experiencing is an
infection, please, please,please, do not wait until it
turns into something that is outof control.
It is especially especially ifit is a wound, if you have a
(06:20):
wound, if it is a wound on anextremity like, outward of your
body, a digit, a foot, a leg, anarm, something far away from
your body, from your trunk.
That means it is being affectedby your blood supply and or
lack thereof, depending on howbad your diabetes is.
Please go see your provider,let them take a look at it.
That may need to be treatedaggressively.
(06:43):
That gets into your system.
Patients with pneumonia I haveseen I don't know about Nicole,
but right now cold and fluseason is rampant and I am
seeing very, very healthy yes,very, very healthy people very
quickly get bronchitis and thenpneumonia and they're going
downhill fast.
Yeah, and I think that's justbecause we are a post COVID
(07:07):
society and we think, oh, I'llget over it, I've done, battled
the worst, you know what?
What?
How worse can it be?
You know I've already had thisand this and this and I'm fine,
it'll go away and it's not.
And if you are a diabetic, it'sjust not.
It's not the time to play.
If you start feeling poorly,please go be seen.
There are so many more thingsthat we can do to help make you
feel much, much better, and alot of that comes down to us
(07:30):
just having a conversation withyou, not only about your
infection but saying whileyou're infected, your blood
sugars will go up, your bloodglucose levels will rise.
Okay, and bacteria, guys?
Bacteria loves glucose, itloves to eat sugar.
So as your glucose levelsincrease, the bacteria becomes
(07:51):
harder and harder for us totreat.
So it becomes very critical forus to keep your glucose levels
under control, especially whileyou're infected.
So let's chat quickly, nicole.
Talk to me about glucosecontrol during an infection.
Let's talk about why that's soimportant.
What would you tell yourpatient?
Nicole (08:09):
Yeah, certainly so.
When your glucose isconsistently over 200, even over
150, like consistently, youknow you're going to eat and
your glucose is consistentlyover 200, even over 150, like
consistently, you know you'regoing to eat and your glucose is
going to go up and down as itnormally should in a normal
person.
However, for those that arediabetic, they have it likes to
stay up higher.
When your glucose is very, veryhigh, your blood is like syrup
(08:32):
going through, and so the oxygenhas a hard time doing its job.
When it's your it's so stickyright Blood carries your oxygen,
but when it's overwhelmed withsugar, it is very difficult for
that oxygen to get transportedwhere it needs to go, especially
in those smaller vessels thatare in the digits and the lower
extremities as well.
(08:53):
So you know being active isimportant to help blood flow.
If it's at all possible, evensmall short walks are important.
But, you know, just to promotethat healing and make sure you
get attention quickly when youstart, because patients that are
diabetic will typically getstarted on antibiotics sooner,
although we, you know we don'twant to overuse.
(09:15):
There's a balance between, youknow, kind of letting yourself
heal and letting um theantibiotics you know take effect
or you know to be prescribed.
But for diabetics we would in alot of cases start antibiotics
sooner than we would a normal,healthy person, and it's
important to get on that soonerrather than later, because it
(09:37):
can just go bad.
It can go really bad, reallyfast.
Kelli (09:40):
Yeah, and you may even hear us say things like a broad
spectrum antibiotics.
You may hear us say things likeresistant organisms or use
words that are not the same thatwe would use for other people,
and that's simply because weknow that our diabetics are more
at risk for bugs that otherpeople wouldn't get.
So your type of infection couldbe a different source of
(10:03):
bacteria than the normal personthat doesn't have diabetes would
get.
Um, simply because it's easierfor those organisms to overgrow
in you.
Um, the other thing that I wantto really really hit home.
I'm going to go all the wayback to the health and wellness
conversation, the reason why westress good nutrition and good
health and wellness.
So many of our patients I knowa lot of my patients when I do
(10:27):
just a baseline lab if you havepoor nutrition, your albumin
levels are low, your proteinlevel is low, pre-albumin stores
are low.
That's a good indication to methat your body is not getting
the protein and fat andnutrients that it needs to be
healthy.
When those levels are low,automatically your body cannot
produce the strength and therobust response to a bacterial
(10:53):
infection or viral infectionthat it needs to fight it.
So one of the things thatunfortunately, diabetics also
face is having a poor nutritionstatus, and that's something
that I hit home with my diabeticpatients is that staying on top
of their nutrition, theirhealth and wellness is
incredibly important Proteindrinks, keeping an eye on their
(11:13):
macros, making sure theirprotein take is adequate.
It's not just about watchingtheir sugars and watching their
carbs, it's about making surethat you get enough protein, and
if you don't have good proteinstores, your body simply cannot
fight off infection.
It can't.
It can't heal those.
That's when those wounds startto break down.
(11:33):
That's when those infectionsstart to take over.
That's when we start to see,especially in diabetic patients,
in their feet and in theirlower extremities when we start
to see those wounds dehisce whatwe say dehisce by meaning the
wound starts to tunnel down intothe tissues.
That can risk getting into thebones, and that's because the
tissues aren't healthy, theblood supply is poor, there's
(11:55):
not enough adequate nutritionfor the body to just take care
of itself.
It's incredibly important.
So I know my patients, I chatwith them.
I know Nicole is really goodabout breaking down those labs
and going over every singlelittle detail with you.
If your provider is not doingthat for you, please ask them to
.
When you go in for yourappointments, ask them what is
(12:16):
my protein?
What is my albumin, myprealbumin?
Do I need to increase myprotein intake?
What does my nutrition looklike?
That's important, it's veryimportant, and it's oftentimes
something that I think sometimesproviders just glance over
because they think, oh well,they just you know, that's just
not important and they justglance over it and keep going.
It's incredibly important,especially in the face of
infection it is.
Nicole (12:37):
it really is, and you can get protein from you know, I
tell my patients, especiallythose that were I'm working with
with obesity, with I don't carehow you get your protein,
really.
Um, if you're diabetic, youwant to watch the sugar, but it
may be cottage cheese.
It has a great protein in it.
It may be a protein bar, like ahealth bar.
(12:57):
It may be a protein shake.
It may be a steak, that's.
You know.
Everything in moderation isokay, based on you know what's
going on with you.
But really, however you get itlike it's better than no way,
right?
So it you know.
It may be a cottage cheese forsome people, it may be a steak
for others.
I'm not a big meat eater, so thecottage cheese and the bars and
(13:21):
stuff is how I get my protein,because I do struggle with that
myself.
But it's super important forhealing and just for prevention.
Don't just kick up your protein, like Kelli saying, when you
have this infection, but overall, for overall wellness, make
sure you are getting goodprotein.
And, just as a general, Kelli,what do you like to see your
(13:46):
patients intake as far asprotein per day?
What is what is a good numberthat patients?
Kelli (13:49):
can say, okay, I need to kind of target this number.
So I tried to get my patientsto get pretty close to their
weight in grams of protein if atall possible, or at least a
third of their calories.
So it depends on what theirweight and what my goal is with
them.
So if I'm trying to get mypatient to lose weight, then I
take their calorie goal for theday and I cut that into a third
(14:12):
and I say this in grams is whatyour protein intake should be.
Okay, if my person is nottrying to lose weight, they are
of average, normal, healthyweight, our weight is good,
we're not overweight, we're notobese, we're not trying to lose
weight, we're trying to maintain.
Then I tell them your weight ingrams is about how much protein
(14:33):
you should be taking in, giveor take 10%, and I try to use
that as my marker.
So it really depends on mypatient.
Am I trying to lose weight, amI trying to maintain?
And I let that be my marker andmy goal.
So for anyone listening, an easyway to think about that if
you're losing weight, calculateyour calories that you want to
(14:54):
take in a day.
So let's say you want to takein 2000 calories a day.
30% of your macros should beprotein.
Okay, if you don't want to loseweight, you want to maintain
your weight, you don't want togain, you don't want to lose
your happy where you are, likeum, I'll just come out and say
it.
I weigh 130 pounds.
About 130 ish grams of proteinis what I try to get in per day.
(15:15):
Sometimes it's a little less,sometimes it's right around
there, but I try to get between100, 125 grams of protein a day.
That's for me.
Now, having said that, you alsowant to be sure that you are
getting in good exercise,because your body needs to be
able to utilize that protein ina way that's effective, for it
to burn fat, store calories, foryou to use in a productive way
(15:42):
and also be able to sustain areally good homeostasis for your
body to be healthy.
Nicole (15:47):
I love it.
That's very, that's very, verygood advice.
That's very good advice.
I like that a lot.
So it is going to depend perpatient, you know, unless you
are on some specific renal dietor on some specific whatever
cardiovascular, but most of thetime protein.
That is a great, a great, greatrule of thumb for for the
majority of patients.
But always check with yourprovider to make sure that that
is, you know, an okay target foryou.
(16:08):
As we're just chatting about itand just kind of giving you a
number.
But the more you ask about whatis my protein level, what is my
albumin, the first time or twoyou're going to it's just going
to be a number to you.
But then the third and fourthtime you're going to be like,
okay, it's up or it's down,what's going on, what do I need
to do?
And so you're not going to knowwhat that number means at first
(16:29):
, and that's okay.
But it's about being consistentand knowing your numbers so
that when something is way up orway down, you're like, okay,
what has changed with me andwhat do I need to do to make
those numbers improve?
Either way?
Kelli (16:43):
And also be sure that when you increase your protein
you increase your water intake.
It's really important.
So, especially in diabetics,you know our kidneys are
important.
In diabetics your kidneysbecome quite a big discussion Um
and so with increasing yourprotein, you have to increase
your water intake too.
You want to make sure that.
You know protein is a bigmolecule and so it needs a lot
of hydration to pass throughyour kidney.
(17:04):
So be sure that you're drinkinga lot of water, and Nicole and
I harp on that a lot too.
So you know, a lot of waterdrink your, drink your water.
Your body weight in water everyday.
Body weight in water every day.
Nicole (17:14):
Yep, unless you have some other condition where you
cannot do that, such as kidneydisease or whatever, but
otherwise, that's that's a verygood rule of thumb for otherwise
healthy individuals.
I think that's all for today.
Thank you for joining us.
We just wanted to get somequick information out there.
We don't want to be want wantboring, but we want to make sure
that, um, you know, we'regetting some good information
out there and um it's infectionseason.
(17:36):
Absolutely A hundred percent.
I've seen so many influences,so many influences, but there is
a test out now that will testfor influenza and COVID.
Kelli (17:44):
Yes, guys, if you haven't seen that, nicole, thanks for
bringing it up.
Um, we're not going to endorseany companies, that's not what
we do.
But yes, nicole brought up agreat topic.
So there is a test kit out nowthat you can test for flu A, flu
B, covid, and you can get itover the counter and you can
have your little test strip allin one.
It does all three all in one,right, love it?
(18:06):
Yeah, I love it.
I love it.
And then guess what guys?
Guess what you can do.
You can, to your little teststrip, have it in front of you,
come see one of us on video,flip it around, let us see the
positive result and we can treatyou and you can go on your way
and you'd never have to leaveyour home.
Nicole (18:21):
It's awesome, so nice.
It's so nice.
No more urgent cares, no moresitting in the waiting rooms,
for you know everybody elsehacking on you.
No, for you know everybody elsehacking on you.
No more waiting to get intoyour primary care and it's days
out, you know it's the weekendor it's the evening.
Let us know, Kelli and I willbe happy to take care of you
anytime.
Kelli (18:41):
And you're wrapped up in your robe with your little
onesie or whatever your favoritecuddle bug is.
We don't care.
You don't have to leave yourhouse, just come see us, we'll
take care of you.
Nicole (18:56):
I see patients in bed all the time and that's okay,
cause that's cause that's wherethey should be.
You know, for the most part,yeah, for sure, for sure.
So thank you for joining us.
Kelli (19:02):
You can find me at hamiltontelehealthcom.
Nicole (19:07):
You can find me at carihealthcom, ch A R I
healthcom.
All right, have a good day.
We'll see you next time.
Bye, guys.
Hey everyone, welcome to another episode of Tattoos and
Telehealth.
My name is Nicole, I'm a nursepractitioner.
This is my great colleague,Kelli, she's also a nurse
practitioner.
And today is my great colleague, Kelli, she's also a nurse
practitioner, and today we'regoing to talk about some pretty
(00:28):
important stuff, especiallyrelated to those with diabetes.
Just as a disclaimer, ourlawyers make a say this does not
constitute a patient providerrelationship and this is not to
be construed as medical advice.
Just two gals talking andhaving a conversation.
So go ahead, Kelli, take it off, let's go.
Kelli (00:47):
So today I kind of want to back up a little bit in the
world of all of the fancy stuff.
But you know, we, we kind ofget especially around the
holidays in the sense of reallytalking about our weight and you
know, those of us gym rats likemyself, we start to notice that
people really get excited about, you know, the first of the
(01:09):
year and we set new year'sresolutions and the gym starts
to become busy and everybodyreally kind of starts getting
focused on that.
But I really want to come backdown to the fact that health and
wellness should be the goal,right?
So instead of weight loss, wereally should be considering
health and wellness as the goal,and with that comes weight loss
(01:30):
, because once you start tobecome more healthy, you will
get that weight off.
Now, the reason why Nicole andI get really really, really
excited about this and we reallykind of hit hard about this is
that one of the biggest, biggestburdens of being overweight,
even just slightly overweight,is the increased risk for
developing type two diabetes.
(01:50):
Right, like?
I don't remember the number.
Do you remember the number,nicole?
The percentage?
Nicole (01:56):
It's over 50.
And I can't think of what thenumber exact number is, but I'll
.
I'll look it up while you'retalking and we'll go from there.
It's the number obesity.
Go ahead, you continue talkingand I'll look it up while you're
talking and we'll go from there.
It's the number obesity.
Go ahead, you continue talkingand I'll look it up.
I'll look in our database.
Kelli (02:09):
The reason why is, as clinicians, we always worry
about patients that are diabeticwhen they present to us with
infections an infection of anykind, really right.
So I get super, super stressedabout skin infections in my
diabetics, especially skininfections in the lower limbs,
because I don't know about you.
But I get super, super stressedabout skin infections in my
diabetics, especially skininfections in the lower limbs,
because I don't know about you,but I get worried about it
(02:29):
getting into the tissues,getting down into the bone that
patient developing osteomyelitis, which is, in layman's terms,
infections that get into thebone of the patient I worry
about to treat.
Yeah, I worry about infectionsin the feet and the reason why
I'm circling back to this rightnow is that some of the latest
(02:51):
articles that are coming outthat Nicole and I get inundated
with daily is one of the morepopular articles that we ascribe
to has just released an articletalking about infections in
type two diabetics and howinfection, just infection
(03:12):
overall, any infection of anykind, infections overall has
risen to the third leading causeof death the third, nicole, of
death in type 2 diabetics.
So patients with diabetes as awhole, infection in general, has
risen to the third leadingcause of death in our patients
with diabetes and that freakedme out.
I was like.
You know how many of mydiabetic patients I treat for
infections, and it's just ingeneral.
Nicole (03:32):
Yeah, so there's so many that it goes beyond just an
acute infection.
But sepsis and that's what Kellitalking about is it goes from
just a in just a, an infectionin, you know, in a small wound
or in a scratch or in whatever.
We don't have good blood supplyas diabetics in the lower
extremities, typicallyespecially advanced, and you
(03:53):
need blood supply with oxygen toheal.
And because the blood supply ispoor to the lower extremities,
it has trouble healing.
So because it has troublehealing, it spreads and it
spreads to be sepsis and that iswhere it's in your bloodstream,
it's everywhere, or, like Kellisaying, it goes to the bone and
that's a huge problem becausethat's when you end up with a
(04:15):
lot of amputations, is when youget the osteomyelitis.
But I did find that obesitysignificantly increases the risk
of developing type 2 diabetesand studies indicate individuals
with obesity are nearly threetimes more likely to be
diagnosed with type 2 diabetesand obesity has been linked to
53 percent of new type 2diabetes diagnoses annually in
(04:39):
the United States.
So this certainly, certainlyenhances the criticality of
making sure that we are reducingthe prevalence of type 2
diabetes, and that is withhealth and wellness and obesity
management Exactly.
Kelli (04:55):
And I want to stress, we are strictly talking about type
2 diabetics today.
I have a lot of love forautoimmune diabetes and type 1
diabetics hold a special placein my heart, but that is a very,
very different conversation.
Okay, so we're not talkingabout you're not talking about
type one diabetics.
We are not talking aboutjuvenile diabetes.
We are talking aboutspecifically type two diabetes.
Okay, guys, so we're not that.
(05:17):
That is a very differentconversation, okay, and the
takeaway to that is that, asyears have gone by, studies have
shown that, as the proportionof deaths have increased to
infection, specific diagnosiscodes even things like pneumonia
(05:37):
has become so prevalent incausing infection related deaths
in diabetics.
It was startling to me and Iwant to get back to visiting for
just a little bit with patientsthat have diabetes and chatting
(05:57):
with you about the importanceof recognizing signs and
symptoms of infection.
Now, this is specifically againfor our diabetes patients.
If you feel like something thatyou are experiencing is an
infection, please, please,please, do not wait until it
turns into something that is outof control.
It is especially especially ifit is a wound, if you have a
(06:20):
wound, if it is a wound on anextremity like, outward of your
body, a digit, a foot, a leg, anarm, something far away from
your body, from your trunk.
That means it is being affectedby your blood supply and or
lack thereof, depending on howbad your diabetes is.
Please go see your provider,let them take a look at it.
That may need to be treatedaggressively.
(06:43):
That gets into your system.
Patients with pneumonia I haveseen I don't know about Nicole,
but right now cold and fluseason is rampant and I am
seeing very, very healthy yes,very, very healthy people very
quickly get bronchitis and thenpneumonia and they're going
downhill fast.
Yeah, and I think that's justbecause we are a post COVID
(07:07):
society and we think, oh, I'llget over it, I've done, battled
the worst, you know what?
What?
How worse can it be?
You know I've already had thisand this and this and I'm fine,
it'll go away and it's not.
And if you are a diabetic, it'sjust not.
It's not the time to play.
If you start feeling poorly,please go be seen.
There are so many more thingsthat we can do to help make you
feel much, much better, and alot of that comes down to us
(07:30):
just having a conversation withyou, not only about your
infection but saying whileyou're infected, your blood
sugars will go up, your bloodglucose levels will rise.
Okay, and bacteria, guys?
Bacteria loves glucose, itloves to eat sugar.
So as your glucose levelsincrease, the bacteria becomes
(07:51):
harder and harder for us totreat.
So it becomes very critical forus to keep your glucose levels
under control, especially whileyou're infected.
So let's chat quickly, nicole.
Talk to me about glucosecontrol during an infection.
Let's talk about why that's soimportant.
What would you tell yourpatient?
Nicole (08:09):
Yeah, certainly so.
When your glucose isconsistently over 200, even over
150, like consistently, youknow you're going to eat and
your glucose is consistentlyover 200, even over 150, like
consistently, you know you'regoing to eat and your glucose is
going to go up and down as itnormally should in a normal
person.
However, for those that arediabetic, they have it likes to
stay up higher.
When your glucose is very, veryhigh, your blood is like syrup
(08:32):
going through, and so the oxygenhas a hard time doing its job.
When it's your it's so stickyright Blood carries your oxygen,
but when it's overwhelmed withsugar, it is very difficult for
that oxygen to get transportedwhere it needs to go, especially
in those smaller vessels thatare in the digits and the lower
extremities as well.
(08:53):
So you know being active isimportant to help blood flow.
If it's at all possible, evensmall short walks are important.
But, you know, just to promotethat healing and make sure you
get attention quickly when youstart, because patients that are
diabetic will typically getstarted on antibiotics sooner,
although we, you know we don'twant to overuse.
(09:15):
There's a balance between, youknow, kind of letting yourself
heal and letting um theantibiotics you know take effect
or you know to be prescribed.
But for diabetics we would in alot of cases start antibiotics
sooner than we would a normal,healthy person, and it's
important to get on that soonerrather than later, because it
(09:37):
can just go bad.
It can go really bad, reallyfast.
Kelli (09:40):
Yeah, and you may even hear us say things like a broad
spectrum antibiotics.
You may hear us say things likeresistant organisms or use
words that are not the same thatwe would use for other people,
and that's simply because weknow that our diabetics are more
at risk for bugs that otherpeople wouldn't get.
So your type of infection couldbe a different source of
(10:03):
bacteria than the normal personthat doesn't have diabetes would
get.
Um, simply because it's easierfor those organisms to overgrow
in you.
Um, the other thing that I wantto really really hit home.
I'm going to go all the wayback to the health and wellness
conversation, the reason why westress good nutrition and good
health and wellness.
So many of our patients I knowa lot of my patients when I do
(10:27):
just a baseline lab if you havepoor nutrition, your albumin
levels are low, your proteinlevel is low, pre-albumin stores
are low.
That's a good indication to methat your body is not getting
the protein and fat andnutrients that it needs to be
healthy.
When those levels are low,automatically your body cannot
produce the strength and therobust response to a bacterial
(10:53):
infection or viral infectionthat it needs to fight it.
So one of the things thatunfortunately, diabetics also
face is having a poor nutritionstatus, and that's something
that I hit home with my diabeticpatients is that staying on top
of their nutrition, theirhealth and wellness is
incredibly important Proteindrinks, keeping an eye on their
(11:13):
macros, making sure theirprotein take is adequate.
It's not just about watchingtheir sugars and watching their
carbs, it's about making surethat you get enough protein, and
if you don't have good proteinstores, your body simply cannot
fight off infection.
It can't.
It can't heal those.
That's when those wounds startto break down.
(11:33):
That's when those infectionsstart to take over.
That's when we start to see,especially in diabetic patients,
in their feet and in theirlower extremities when we start
to see those wounds dehisce whatwe say dehisce by meaning the
wound starts to tunnel down intothe tissues.
That can risk getting into thebones, and that's because the
tissues aren't healthy, theblood supply is poor, there's
(11:55):
not enough adequate nutritionfor the body to just take care
of itself.
It's incredibly important.
So I know my patients, I chatwith them.
I know Nicole is really goodabout breaking down those labs
and going over every singlelittle detail with you.
If your provider is not doingthat for you, please ask them to
.
When you go in for yourappointments, ask them what is
(12:16):
my protein?
What is my albumin, myprealbumin?
Do I need to increase myprotein intake?
What does my nutrition looklike?
That's important, it's veryimportant, and it's oftentimes
something that I think sometimesproviders just glance over
because they think, oh well,they just you know, that's just
not important and they justglance over it and keep going.
It's incredibly important,especially in the face of
infection it is.
Nicole (12:37):
it really is, and you can get protein from you know, I
tell my patients, especiallythose that were I'm working with
with obesity, with I don't carehow you get your protein,
really.
Um, if you're diabetic, youwant to watch the sugar, but it
may be cottage cheese.
It has a great protein in it.
It may be a protein bar, like ahealth bar.
(12:57):
It may be a protein shake.
It may be a steak, that's.
You know.
Everything in moderation isokay, based on you know what's
going on with you.
But really, however you get itlike it's better than no way,
right?
So it you know.
It may be a cottage cheese forsome people, it may be a steak
for others.
I'm not a big meat eater, so thecottage cheese and the bars and
(13:21):
stuff is how I get my protein,because I do struggle with that
myself.
But it's super important forhealing and just for prevention.
Don't just kick up your protein, like Kelli saying, when you
have this infection, but overall, for overall wellness, make
sure you are getting goodprotein.
And, just as a general, Kelli,what do you like to see your
(13:46):
patients intake as far asprotein per day?
What is what is a good numberthat patients?
Kelli (13:49):
can say, okay, I need to kind of target this number.
So I tried to get my patientsto get pretty close to their
weight in grams of protein if atall possible, or at least a
third of their calories.
So it depends on what theirweight and what my goal is with
them.
So if I'm trying to get mypatient to lose weight, then I
take their calorie goal for theday and I cut that into a third
(14:12):
and I say this in grams is whatyour protein intake should be.
Okay, if my person is nottrying to lose weight, they are
of average, normal, healthyweight, our weight is good,
we're not overweight, we're notobese, we're not trying to lose
weight, we're trying to maintain.
Then I tell them your weight ingrams is about how much protein
(14:33):
you should be taking in, giveor take 10%, and I try to use
that as my marker.
So it really depends on mypatient.
Am I trying to lose weight, amI trying to maintain?
And I let that be my marker andmy goal.
So for anyone listening, an easyway to think about that if
you're losing weight, calculateyour calories that you want to
(14:54):
take in a day.
So let's say you want to takein 2000 calories a day.
30% of your macros should beprotein.
Okay, if you don't want to loseweight, you want to maintain
your weight, you don't want togain, you don't want to lose
your happy where you are, likeum, I'll just come out and say
it.
I weigh 130 pounds.
About 130 ish grams of proteinis what I try to get in per day.
(15:15):
Sometimes it's a little less,sometimes it's right around
there, but I try to get between100, 125 grams of protein a day.
That's for me.
Now, having said that, you alsowant to be sure that you are
getting in good exercise,because your body needs to be
able to utilize that protein ina way that's effective, for it
to burn fat, store calories, foryou to use in a productive way
(15:42):
and also be able to sustain areally good homeostasis for your
body to be healthy.
Nicole (15:47):
I love it.
That's very, that's very, verygood advice.
That's very good advice.
I like that a lot.
So it is going to depend perpatient, you know, unless you
are on some specific renal dietor on some specific whatever
cardiovascular, but most of thetime protein.
That is a great, a great, greatrule of thumb for for the
majority of patients.
But always check with yourprovider to make sure that that
is, you know, an okay target foryou.
(16:08):
As we're just chatting about itand just kind of giving you a
number.
But the more you ask about whatis my protein level, what is my
albumin, the first time or twoyou're going to it's just going
to be a number to you.
But then the third and fourthtime you're going to be like,
okay, it's up or it's down,what's going on, what do I need
to do?
And so you're not going to knowwhat that number means at first
(16:29):
, and that's okay.
But it's about being consistentand knowing your numbers so
that when something is way up orway down, you're like, okay,
what has changed with me andwhat do I need to do to make
those numbers improve?
Either way?
Kelli (16:43):
And also be sure that when you increase your protein
you increase your water intake.
It's really important.
So, especially in diabetics,you know our kidneys are
important.
In diabetics your kidneysbecome quite a big discussion Um
and so with increasing yourprotein, you have to increase
your water intake too.
You want to make sure that.
You know protein is a bigmolecule and so it needs a lot
of hydration to pass throughyour kidney.
(17:04):
So be sure that you're drinkinga lot of water, and Nicole and
I harp on that a lot too.
So you know, a lot of waterdrink your, drink your water.
Your body weight in water everyday.
Body weight in water every day.
Nicole (17:14):
Yep, unless you have some other condition where you
cannot do that, such as kidneydisease or whatever, but
otherwise, that's that's a verygood rule of thumb for otherwise
healthy individuals.
I think that's all for today.
Thank you for joining us.
We just wanted to get somequick information out there.
We don't want to be want wantboring, but we want to make sure
that, um, you know, we'regetting some good information
out there and um it's infectionseason.
(17:36):
Absolutely A hundred percent.
I've seen so many influences,so many influences, but there is
a test out now that will testfor influenza and COVID.
Kelli (17:44):
Yes, guys, if you haven't seen that, nicole, thanks for
bringing it up.
Um, we're not going to endorseany companies, that's not what
we do.
But yes, nicole brought up agreat topic.
So there is a test kit out nowthat you can test for flu A, flu
B, covid, and you can get itover the counter and you can
have your little test strip allin one.
It does all three all in one,right, love it?
(18:06):
Yeah, I love it.
I love it.
And then guess what guys?
Guess what you can do.
You can, to your little teststrip, have it in front of you,
come see one of us on video,flip it around, let us see the
positive result and we can treatyou and you can go on your way
and you'd never have to leaveyour home.
Nicole (18:21):
It's awesome, so nice.
It's so nice.
No more urgent cares, no moresitting in the waiting rooms,
for you know everybody elsehacking on you.
No, for you know everybody elsehacking on you.
No more waiting to get intoyour primary care and it's days
out, you know it's the weekendor it's the evening.
Let us know, Kelli and I willbe happy to take care of you
anytime.
Kelli (18:41):
And you're wrapped up in your robe with your little
onesie or whatever your favoritecuddle bug is.
We don't care.
You don't have to leave yourhouse, just come see us, we'll
take care of you.
Nicole (18:56):
I see patients in bed all the time and that's okay,
cause that's cause that's wherethey should be.
You know, for the most part,yeah, for sure, for sure.
So thank you for joining us.
Kelli (19:02):
You can find me at hamiltontelehealthcom.
Nicole (19:07):
You can find me at carihealthcom, ch A R I
healthcom.
All right, have a good day.
We'll see you next time.
Bye, guys.
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